Introduction

The AIDS and Drug Misuse Working Group

1 The Advisory Council on the Misuse of Drugs at its meeting in May 1987 discussed the problem of the spread of HIV virus and AIDS among injecting drug misusers. It agreed that a Working Group should be set up as a matter of urgency to consider the implications of HIV and AIDS for drug misuse services and to make recommendations on how the problem should be tackled. The establishment of a Working Group was welcomed by Ministers, who agreed to provide the necessary Secretarial and other support.

2 The Working Group's Membership and Terms of Reference are at Annex A. Although the Group's remit covers all the implications of AIDS and HIV for drug misuse services, the Group decided to concentrate initially on measures which could be taken to stem the spread of the virus through injecting drug misuse.

3 Over the last four months the Group has taken oral evidence from some 30 witnesses with expertise in the drug misuse and AIDS fields. It has also received written evidence from some 40 further individuals and bodies. Annex B gives an indication of the range of individuals and bodies from whom evidence has been received. In addition the Group has studied a number of relevant research papers and summaries.
Scope of this First Report

4 This first report is concerned with measures to combat the spread of the virus. Wider aspects of the problem, particularly the management of drug users who are infected with the virus and those who have AIDS, will be covered in our second report.

5 This work covers the UK as a whole and the conclusions and recommendations should be taken to apply to all parts of the UK except where otherwise stated. We make some additional recommendations for Scotland in Chapter 7 and make some brief comments particular to Wales and Northern Ireland in Annex F. Throughout the report we have, for convenience, described services in English terms (e.g. Health Regions and Districts); for Scotland, Wales and Northern Ireland the relevant equivalent terms should be read.
Policy Background — AIDS, HIV and Injecting Drug Misuse

6 The Acquired Immune Deficiency Syndrome (AIDS) is a new and deadly condition caused by a virus known as the Human Immunodeficiency Virus (HIV). The first reported cases of AIDS in homosexual men and drug misusers occurred in the USA in 1981. Since then, the disease has spread rapidly. There have now been some 60,000 reported cases worldwide, including 1227 (by December 1987) in the United Kingdom. The World Health Organisation estimates that, throughout the world, there are 5-10 million people infected with HIV, and that in the next five years between # million and 3 million deaths can be expected.

7 The virus — HIV — is found in semen, blood and some other body fluids and can be transmitted through transfer of these fluids. The overwhelming epidemiological evidence is that the main methods of transmission are:
—    sexual intercourse (both heterosexual and homosexual);
—    injecting drug misuse using contaminated needles and syringes and other equipment;
—    medical use of infected blood and blood products;
—    in utero infection of the unborn babies of infected mothers.

8 Injecting drug misuse using contaminated equipment has been identified as the method of transmission of the virus in 16 per cent of the known cases of infection in the UK as a whole. In Scotland, Italy and Spain, it accounts for over half of all known cases of infection with HIV. At present, in many parts of the USA and Europe, it is also the major way in which the virus is introduced into the heterosexual population.

9 Drug misuse is an illicit activity and drug misusers can be hard to make contact with. Persuading them to change their behaviour can be very difficult. Yet it is essential to do so if the spread of HIV is to be contained.

10 As part of its strategy to tackle AIDS the UK Government introduced three measures in 1987 aimed specifically at combating the spread of the virus through injecting drug misuse:
—    first, the launch of a new AIDS and drug misuse publicity campaign designed to highlight to drug misusers the dangers of injecting, and particularly of sharing equipment. A complementary campaign aimed at discouraging drug misuse was run in parallel;
—    second, the provision of extra resources to help drug misuse services play a growing role in the fight against AIDS; and
—    third, the establishment of 15 pilot schemes where injecting drug misusers can exchange used needles and syringes for clean equipment. These schemes are being evaluated to help assess their effectiveness.

11 It was against this background that the Working Group began its work.